The overall likelihood of surviving primary lung cancer beyond five years is approximately 15%. Those who survive beyond five years after a cancer diagnosis have been referred to as long-term survivors. To date, there is limited information about the health status, health behavior, and quality of life (QoL) among long-term lung cancer (LTLC) survivors. This application will primarily focus on a descriptive study of clinical outcomes and general health. Predictors of a longer survival and better QoL among LTLC survivors will be investigated. We will use a conceptual framework developed by Wilson and Clean/7 as a guideline in analyzing health-related QoL. To accomplish our goal, we will utilize an established comprehensive lung cancer resource and expand the current patient cohort that has been followed for a minimum of five years to ten years post diagnosis. Since 2001, more than 120 patients each year in our clinical research program become LTLC survivors and are prospectively followed annually;and therefore, over 1000 survivors will be participants in this proposed study by the year 2010. In Specific Aim 1. We seek to gain a better understanding of the long-term outcomes of these LTLC survivors (including second primary cancers, overall and disease-free survival, and cause of death of deceased patients), their health behaviors, and their QoL. The characteristics of LTLC survivors in the following four major categories will be described: (1) lung cancer therapy including type of treatment, specific regimens, tumor responses, and side effects;(2) subsequent clinical events including new primary cancer(s) and other co-morbid conditions;(3) selected health behaviors including physical activity level, dietary patterns, and tobacco use;and (4) health-related quality of life in five domains: physical, mental, emotional, social, and spiritual well-being. In Specific Aim 2. We will evaluate the effects of factors described in Aim 1 on patients'long-term outcome and QoL. Statistical models will be established for defining predictors of QoL and survival time. By accomplishing this aim, we will gain further understanding about the QoL and health of LTLC survivors in multiple respects of their life, and identify significant contributing factors to improved QoL and prolonged survival. As an important exploratory step, Specific Aim 3 will be focused on identifying biological markers, and their roles in concert with other important prognostic factors identified from Aim 2, in predicting outcomes of lung cancer patients by two sets of case-case comparisons: stage I non small cell lung cancer (NSCLC) patients who died of lung cancer within two years versus those who become LTLC survivors;and stage III NSCLC patients who survived beyond five years after diagnosis versus those who died of lung cancer within two years. New knowledge gained from our proposed study may help lung cancer survivors, their healthcare providers, their caregivers, and the general public by providing evidence for establishing clinical recommendations to enhance their long-term survival and health-related QoL.